Introduction: Malnutrition is an important risk factor for patient surgical outcomes. This is especially true for head and neck cancer patients receiving a total laryngectomy (TL) with free flap reconstruction (FFR). Preoperative prealbumin and albumin values have both been used to indicate poor nutrition. While low albumin has been studied in head and neck cancer in general, laryngectomy patients have a unique set of wound healing complications that have significant morbidity and mortality. The aim of this study is to identify the prognostic value of preoperative prealbumin and albumin levels with wound healing complications and readmissions in head and neck cancer patients with TL and FFR.
Methods: A retrospective review was conducted in all patients who underwent head and neck oncologic surgery with TL and FFR from 2016-2022 at a tertiary-care institution. Only patients with either preoperative (within 1 month of surgery) prealbumin or albumin lab values were included. Low prealbumin levels and low albumin levels were defined as < 20 mg/dL and <3.4 g/dL, respectively. Outcomes collected included any wound healing complications (e.g., wound dehiscence, fistula, infection, and salivary leak), return to the operating room (RTOR), and readmission. Wound healing complications and nutritional markers were compared using chi-squared, t-test, fisher's exact test analysis, and multivariable logistic regression.
Results: A total of 83 patients met the inclusion criteria. The mean age at surgery was 61.6 ± 9.3. The majority of patients were male (72.3%) and Caucasian (91.5%). 34.9% of patients had radiation prior to TL and FFR. There were 64 patients (77.1%) with preoperative prealbumin lab values, 37/64 (44.6%) of these patients had a low preoperative prealbumin level. There were 82 patients (98.8%) with preoperative albumin lab values, 26/82 (31.7%) of these patients had low preoperative albumin levels. There was an association between low preoperative prealbumin levels and any wound healing complication and wound dehiscence. On multivariate analysis, low preoperative prealbumin levels were associated with any postoperative wound healing complications (OR, 4.7; CI 1.3 – 17.0. P = 0.02) after controlling for preoperative albumin level, age, smoking, and preoperative radiation.
Conclusions: TL patients with low preoperative prealbumin levels were associated with wound healing complications including wound dehiscence. Consideration of more frequent prealbumin testing in HNC patients with TL and FFR may lead to better mitigation of post-operative wound healing complications.